vestarВестник аритмологииJournal of Arrhythmology1561-86412658-7327НАО «Инкарт»10.35336/VA-1327HKHUDFvestar-1400Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESИзменение положения пищевода во время радиочастотной аблации устьев легочных вен минимально по данным эзофагографииThe change in the position of the esophagus during radiofrequency ablation of the pulmonary veins is minimal according to esophagographyhttps://orcid.org/0000-0001-6089-9722БазылевВ. В.BazylevV. V.

Пенза, ул. Стасова, д. 6

Penza, 6 Stasova str

https://orcid.org/0000-0002-0529-0081КозловА. В.KozlovA. V.

Козлов Александр Викторович

Пенза, ул. Стасова, д. 6

Kozlov Aleksander

Penza, 6 Stasova str

kozlov3619@yandex.ruhttps://orcid.org/0000-0002-4973-510XДурмановС. С.DurmanovS. S.

Пенза, ул. Стасова, д. 6

Penza, 6 Stasova str

ФГБУ «Федеральный центр сердечно-сосудистой хирургии» МЗ РФРоссияFederal Center for Cardiovascular Surgery the MH RFRussian Federation2024230920243131924Copyright © Базылев В.В., Козлов А.В., Дурманов С.С., 20242024Базылев В.В., Козлов А.В., Дурманов С.С.Bazylev V.V., Kozlov A.V., Durmanov S.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestar.elpub.ru/jour/article/view/1400Цель

Цель. Изучить изменение положения пищевода во время радиочастотной аблации устьев легочных вен (РЧА УЛВ), используя эзофагографию.

Материал и методы исследования. Период проведения исследования с августа 2022 года по январь 2023 года включительно. Исследование одноцентровое обсервационное нерандомизированное. В исследование был включен 191 пациент. РЧА УЛВ проводилась под внутривенной седацией дексмедетомидином и фентанилом. Пациенты были доступны словесному контакту в течении всей операции. После выполнения транссептальной пункции проводилась эзофагография в проекции LAO 30° с использованием 10 мл водорастворимого контрастного вещества Омнипак (GE HEALTHCARE IRELAND). В конце операции эзофагография выполнялась повторно. Положение пищевода определялось относительно тени позвоночника. Измерения проводились на трех уровнях: верхний на пересечении пищевода и крыши левого предсердия, нижний на пересечении с кольцом митрального клапана; средний уровень на середине расстояния между верхним и нижним. На этих же уровнях проводилось измерение ширины контрастируемого просвета пищевода. Боковое смещение пищевода определялось как разница в значениях измерений положения латеральной и медиальной границ тени пищевода на эзофагограммах, полученных в начале и конце операции.

Результаты

Результаты. Среднее боковое смещение пищевода составило 2,0±1,9 мм на верхнем уровне, 3,4±1,6 мм на среднем уровне и 1,4±1,2 мм на нижнем уровне левого предсердия. Достоверной статистически значимой разницы в изменении положения пищевода в начале и конце операции не получено (p=0,251, p=0,558, p=0,824 соответственно для верхнего, среднего и нижнего уровней измерения). Самое значительное смещение тени пищевода составило 5,3 мм. Максимальное изменение ширины контрастируемого просвета пищевода составило 5,5 мм.

Заключение

Заключение. По данным эзофагографии с водорастворимым контрастом пищевод во время РЧА УЛВ не испытывает клинически значимого смещения.

Aim

Aim. To study the change in the position of the esophagus during radiofrequency ablation of the pulmonary veins (RFA PV) using esophagography

Methods

Methods. The period of the study is from August 2022 to January 2023 inclusive. The study is a single-center observational non-randomized study. The study included 191 patients. RFA PV were performed under conscious sedation with dexmedetomidine and fentanyl. The patients were available for verbal contact throughout the operation. After performing a transeptal puncture, esophagography was performed in the LAO 30° projection using 10 ml of Omnipac water-soluble contrast agent (GE Healthcare Ireland). At the end of the operation, esophagography was performed repeatedly. The position of the esophagus was determined relative to the shadow of the spine. Measurements were carried out at three levels: the upper one at the intersection of the esophagus and the roof of the left atrium, the lower one at the intersection with the ring of the mitral valve; the middle level at the middle of the distance between the upper and lower measurements. The width of the contrasted lumen of the esophagus was measured at the same levels. Lateral displacement of the esophagus was defined as the difference in the values of measurements of the position of the lateral and medial boundaries of the esophageal shadow on esophagograms obtained at the beginning and end of the operation.

Results

Results. The average lateral displacement of the esophagus was 2.0 ±1.9 mm at the upper level, 3.4±1.6 mm at the middle level and 1.4±1.2 mm at the lower level of the left atrium. There was no significant statistically difference in the change in the position of the esophagus at the beginning and end of the operation (p=0.251, p=0.558, p=0.824, respectively, for the upper, middle and lower measurement levels). The most significant displacement of the esophageal shadow was 5.3 mm. The maximum change in the width of the contrasted lumen of the esophagus was 5.5 mm.

Conclusions

Conclusions. According to esophagography with water-soluble contrast, the position of the esophagus during RFA PV does not experience clinically significant changes.

фибрилляция предсердийлегочные венырадиочастотная аблацияпищеводэзофагографияосложненияatrial fibrillationpulmonary veinsradiofrequency ablationesophagusesophagographycomplicationsReferencesКозлов АВ, Дурманов СС, Базылев ВВ. Задняя стенка левого предсердия как мишень при катетерной аблации фибрилляции предсердий. Креативная кардиология. 2020;14(4): 368-76. https://doi.org/10.24022/1997-3187-2020-14-4-368-376.Kozlov AV, Durmanov SS, Bazylev VV. The posterior wall of the left atrium as a target for catheter ablation of atrial fibrillation. Creative Cardiology. 2020;14(4): 368-76 (In Russ.) https://doi.org/10.24022/1997-3187-2020-14-4-368-376.Han H, Ha F, Sanders P, et al. Atrioesophageal Fistula: Clinical Presentation, Procedural Characteristics, Diagnostic Investigations, and Treatment Outcomes. Circ Arrhythm Electrophysiol. 2017;10(11): e005579. https://doi.org/10.1161/CIRCEP.117.005579.Han H, Ha F, Sanders P, et al. Atrioesophageal Fistula: Clinical Presentation, Procedural Characteristics, Diagnostic Investigations, and Treatment Outcomes. Circ Arrhythm Electrophysiol. 2017;10(11): e005579. https://doi.org/10.1161/CIRCEP.117.005579.Zhang P, Zhang YY, Ye Q, et al. Characteristics of Atrial Fibrillation Patients Suffering Esophageal Injury Caused by Ablation for Atrial Fibrillation. Sci Rep. 2020;10(1): 2751. https://doi.org/10.1038/s41598-020-59539-6.Zhang P, Zhang YY, Ye Q, et al. Characteristics of Atrial Fibrillation Patients Suffering Esophageal Injury Caused by Ablation for Atrial Fibrillation. Sci Rep. 2020;10(1): 2751. https://doi.org/10.1038/s41598-020-59539-6.Ye Y, Chen Sq, Lu Yf, et al. PV isolation guided by esophageal visualization with a tailored ablation strategy for the avoidance of esophageal thermal injury: a randomized trial. J Interv Card Electrophysiol. 2020;58(2): 219-227. https://doi.org/10.1007/s10840-019-00572-5.Ye Y, Chen Sq, Lu Yf, et al. PV isolation guided by esophageal visualization with a tailored ablation strategy for the avoidance of esophageal thermal injury: a randomized trial. J Interv Card Electrophysiol. 2020;58(2): 219-227. https://doi.org/10.1007/s10840-019-00572-5.Bahnson T. Strategies to minimize the risk of esophageal injury during catheter ablation for atrial fibrillation. Pacing Clin Electrophysiol. 2009;32(2): 248-60. https://doi.org/10.1111/j.1540-8159.2008.02210.x.Bahnson T. Strategies to minimize the risk of esophageal injury during catheter ablation for atrial fibrillation. Pacing Clin Electrophysiol. 2009;32(2): 248-60. https://doi.org/10.1111/j.1540-8159.2008.02210.x.Good E, Oral H, Lemola, et al. Movement of the esophagus during left atrial catheter ablation for atrial fibrillation. J Am Coll Cardiol. 2005; 46:2107-2110. https://doi.org/10.1016/j.jacc.2005.08.042.Good E, Oral H, Lemola, et al. Movement of the esophagus during left atrial catheter ablation for atrial fibrillation. J Am Coll Cardiol. 2005; 46:2107-2110. https://doi.org/10.1016/j.jacc.2005.08.042.Daoud E, Hummel J, Houmsse M, et al. Comparison of computed tomography imaging with intraprocedural contrast esophagram: implications for catheter ablation of atrial fibrillation. Heart Rhythm. 2008;5(7): 975-80. https://doi.org/10.1016/j.hrthm.2008.03.058.Daoud E, Hummel J, Houmsse M, et al. Comparison of computed tomography imaging with intraprocedural contrast esophagram: implications for catheter ablation of atrial fibrillation. Heart Rhythm. 2008;5(7): 975-80. https://doi.org/10.1016/j.hrthm.2008.03.058.Zdenek S, Frantisek L, Jiri J, et al. Esophageal positions relative to the left atrium; data from 293 patients before catheter ablation of atrial fibrillation. Indian Heart Journal. 2018;70(1): 37-44. https://doi.org/10.1016/j.ihj.2017.06.013.Zdenek S, Frantisek L, Jiri J, et al. Esophageal positions relative to the left atrium; data from 293 patients before catheter ablation of atrial fibrillation. Indian Heart Journal. 2018;70(1): 37-44. https://doi.org/10.1016/j.ihj.2017.06.013.Sherzer A, Feigenblum D, Kulkarni S, et al. Continuous nonfluoroscopic localization of the esophagus during radiofrequency catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2007;18(2): 157-60. https://doi.org/10.1111/j.1540-8167.2006.00674.x.Sherzer A, Feigenblum D, Kulkarni S, et al. Continuous nonfluoroscopic localization of the esophagus during radiofrequency catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2007;18(2): 157-60. https://doi.org/10.1111/j.1540-8167.2006.00674.x.Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. Heart Rhythm. 2017;14(10): e445-e494. https://doi.org/10.1016/j.hrthm.2017.07.009.Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. Heart Rhythm. 2017;14(10): e445-e494. https://doi.org/10.1016/j.hrthm.2017.07.009.Попылькова ОВ, Дурманов СС, Базылев ВВ, и др. Варфарин против прямых оральных антикоагулянтов: как отличается степень коагуляции во время катетерной аблации фибрилляции предсердий. Вестник аритмологии. 2022;29(3): 13-20. https://doi.org/10.35336/VA-2022-3-02.Popylkova OV, Durmanov SS, Bazylev VV, et al. Warfarin versus direct oral anticoagulants: how the degree of coagulation differs during catheter ablation of atrial fibrillation. Journal of Arrhythmology. 2022;29(3): 13-20. (In Russ.) https://doi.org/10.35336/VA-2022-3-02.Доступно из: https://www.rlsnet.ru/drugs/omnipak-2313.Available from: https://www.rlsnet.ru/drugs/omnipak-2313.Thomas Ph, Milad E, Duytschaever M, et al. Improving procedural and one-year outcome after contact force-guided pulmonary vein isolation: the role of interlesion distance, ablation index, and contact force variability in the ‘CLOSE’-protocol. Europace. 2018;1;20(FI_3): f419-f427. https://doi.org/10.1093/europace/eux376.Thomas Ph, Milad E, Duytschaever M, et al. Improving procedural and one-year outcome after contact force-guided pulmonary vein isolation: the role of interlesion distance, ablation index, and contact force variability in the ‘CLOSE’-protocol. Europace. 2018;1;20(FI_3): f419-f427. https://doi.org/10.1093/europace/eux376.Krishnan S, Salazar M, Narula N. Anatomical basis for the mobility of the esophagus: implications for catheter ablation of atrial fibrillation. Indian Pacing Electrophysiol J. 2008;8(1): 66-68.Krishnan S, Salazar M, Narula N. Anatomical basis for the mobility of the esophagus: implications for catheter ablation of atrial fibrillation. Indian Pacing Electrophysiol J. 2008;8(1): 66-68.Stárek Z, Lehar F, Jež J, et al. Long-term mobility of the esophagus in patients undergoing catheter ablation of atrial fibrillation: data from computer tomography and 3D rotational angiography of the left atrium. J Interv Card Electrophysiol. 2016;46(2): 81-87. https://doi.org/10.1007/s10840-016-0121-x.Stárek Z, Lehar F, Jež J, et al. Long-term mobility of the esophagus in patients undergoing catheter ablation of atrial fibrillation: data from computer tomography and 3D rotational angiography of the left atrium. J Interv Card Electrophysiol. 2016;46(2): 81-87. https://doi.org/10.1007/s10840-016-0121-x.Harris JA, Bartelt D, Campion M, et al. The use of low-osmolar water-soluble contrast in videofluoroscopic swallowing exams. Dysphagia. 2013;28(4): 520-527. https://doi.org/10.1007/s00455-013-9462-0.Harris JA, Bartelt D, Campion M, et al. The use of low-osmolar water-soluble contrast in videofluoroscopic swallowing exams. Dysphagia. 2013;28(4): 520-527. https://doi.org/10.1007/s00455-013-9462-0.Schoene K., Arya A, Grashoff F, et al. Oesophageal Probe Evaluation in Radiofrequency Ablation of Atrial Fibrillation (OPERA): results from a prospective randomized trial. Europace. 2020;22(10):1487-1494. https://doi.org/10.1093/europace/euaa209.Schoene K., Arya A, Grashoff F, et al. Oesophageal Probe Evaluation in Radiofrequency Ablation of Atrial Fibrillation (OPERA): results from a prospective randomized trial. Europace. 2020;22(10):1487-1494. https://doi.org/10.1093/europace/euaa209.Schoene K, Arya A, Grashoff F, et al. Oesophageal Probe Evaluation in Radiofrequency Ablation of Atrial Fibrillation (OPERA): results from a prospective randomized trial. Europace. 2020;22(10):1487-1494. https://doi.org/10.1093/europace/euaa209.Schoene K, Arya A, Grashoff F, et al. Oesophageal Probe Evaluation in Radiofrequency Ablation of Atrial Fibrillation (OPERA): results from a prospective randomized trial. Europace. 2020;22(10):1487-1494. https://doi.org/10.1093/europace/euaa209.Müller P, Dietrich J, Halbfass P, et al. Higher incidence of esophageal lesions after ablation of atrial fibrillation related to the use of esophageal temperature probes. Heart Rhythm. 2015;12(7): 1464-1469. https://doi.org/10.1016/j.hrthm.2015.04.005.Müller P, Dietrich J, Halbfass P, et al. Higher incidence of esophageal lesions after ablation of atrial fibrillation related to the use of esophageal temperature probes. Heart Rhythm. 2015;12(7): 1464-1469. https://doi.org/10.1016/j.hrthm.2015.04.005.Рачкова ЮИ, Сергеева ОА, Рзаев ФГ, и др. Влияние дополнительных воздействий в левом предсердии на эффективность криобаллонной аблации у пациентов с пароксизмальной формой фибрилляции предсердий. Вестник аритмологии. 2023;30(2): 27-34. https://doi.org/10.35336/VA-2023-2-04.Rachkova II, Sergeeva OA, Rzaev FG, et al. Additional left atrial lesions improve the effect of cryoballoon pulmonary vein isolation in paroxysmal atrial fibrillation patients. Journal of Arrhythmology. 2023;30(2): 27-34. (In Russ.) https://doi.org/10.35336/VA-2023-2-04.Koruth J, Reddy V, Miller M, et al. Mechanical esophageal displacement during catheter ablation for atrial fibrillation. Journal of Cardiovascular Electrophysiology. 2012;23(2):147-154. https://doi.org/10.1111/j.1540-8167.2011.02162.x.Koruth J, Reddy V, Miller M, et al. Mechanical esophageal displacement during catheter ablation for atrial fibrillation. Journal of Cardiovascular Electrophysiology. 2012;23(2):147-154. https://doi.org/10.1111/j.1540-8167.2011.02162.x.Mateos J, Lobo T, Vargas R, et al. Simplified method for esophagus protection during radiofrequency catheter ablation of atrial fibrillation-prospective study of 704 cases. Brazilian Journal of Cardiovascular Surgery. 2015;30(2): 139-147. https://doi.org/10.5935/1678-9741.20150009.Mateos J, Lobo T, Vargas R, et al. Simplified method for esophagus protection during radiofrequency catheter ablation of atrial fibrillation-prospective study of 704 cases. Brazilian Journal of Cardiovascular Surgery. 2015;30(2): 139-147. https://doi.org/10.5935/1678-9741.20150009.John J, Garg L, Orosey M, et al. The effect esophagus cooling on esophageal injury during radiofrequency catheter ablation of atrial fibrillation. Journal of Interventional Cardiac Electrophysiology. 2020;58(1): 43-50. https://doi.org/10.1007/s10840-019-00566-3John J, Garg L, Orosey M, et al. The effect esophagus cooling on esophageal injury during radiofrequency catheter ablation of atrial fibrillation. Journal of Interventional Cardiac Electrophysiology. 2020;58(1): 43-50. https://doi.org/10.1007/s10840-019-00566-3Calvert P, Lip G, Gupta D. Radiofrequency catheter ablation of atrial fibrillation: A review of techniques. Trends Cardiovasc Med. 2023;33(7): 405-415. https://doi.org/10.1016/j.tcm.2022.04.002.Calvert P, Lip G, Gupta D. Radiofrequency catheter ablation of atrial fibrillation: A review of techniques. Trends Cardiovasc Med. 2023;33(7): 405-415. https://doi.org/10.1016/j.tcm.2022.04.002.Kobza R, Schoenenberger A, Erne P. Esophagus imaging for catheter ablation of atrial fibrillation: comparison of two methods with showing of esophageal movement. Journal of Interventional Cardiac Electrophysiology. 2009;26(3): 159-164. https://doi.org/10.1007/s10840-009-9434-3.Kobza R, Schoenenberger A, Erne P. Esophagus imaging for catheter ablation of atrial fibrillation: comparison of two methods with showing of esophageal movement. Journal of Interventional Cardiac Electrophysiology. 2009;26(3): 159-164. https://doi.org/10.1007/s10840-009-9434-3.Harris JA, Bartelt D, Campion M. The use of low-osmolar water-soluble contrast in videofluoroscopic swallowing exams. Dysphagia. 2013;28(4):520-527.Harris JA, Bartelt D, Campion M. The use of low-osmolar water-soluble contrast in videofluoroscopic swallowing exams. Dysphagia. 2013;28(4):520-527.Доступно из: https://doi.org/10.1007/s00455-013-9462-0.Available from: https://doi.org/10.1007/s00455-013-9462-0.

The authors declare that there are no conflicts of interest present.